AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

A U S T R A L I A N COLLEGE OF M I D W I V E S I N C O R P O R A T E D A.R.B.N. 051 459 628

P R O X Y FORM

I (BLOCK LETTERS)

of

being a financial member of the Australian College of Midwives Incorporated, HEREBY APPOINT

of

a financial member of the College as my proxy to vote and act on my behalf at the General Meeting of Members

of the Australian College of Midwives Incorporated, to be held on Thursday, September 14, 1995.

This form is to be used to record a vote in favour of / against

(Strike out whichever is not desired)

1. Resolution for increase in Capitation Fees for the 1996-1998 period - - in favour of

- - against

Signature of financial member Date

1995

Signature of witness Date

1995

NOTE:

Proxy forms may be lodged with the College at its Registered Office,

Suite 23,431 St Kilda Road, Melbourne, Victoria 3004

b e f o r e 5 . 0 0 p m o n S e p t e m b e r 7, 1 9 9 5 .

A financial member entitled to attend and vote at the above meeting, is entitled to appoint a proxy to

attend and vote instead of that member.

A proxy must be a financial member of the College, and is not entitled to vote except on a poll.

SEPTEMBER 1995 ACMIJOURNAL PAGE 17